Posterior malleolus fractures are quite common and usually result from rotational ankle injuries. For the management of posterior malleolus fractures, more studies are still required, though it is already well-recogni...Posterior malleolus fractures are quite common and usually result from rotational ankle injuries. For the management of posterior malleolus fractures, more studies are still required, though it is already well-recognized for medial and lateral structure. Therefore, fracture of posterior malleolus is striking subject of study among orthopedic surgeons. Most orthopedic surgeons recommend fixing the posterior malleolus fracture if it is larger than 25% to 33% of the distal articular surface. Further attention is required for the reduction and fixation of fractures involving posterior malleolus. Several approaches and methods for fixation of posterior malleolus have been defined in the literature. Previously, the most common method of fixation of the posterior malleolus is by indirect reduction and antero-posterior screws, it is minimally invasive, the anterior incision does not allow satisfactory visualization of the fragment, so good anatomical reduction is difficult to achieve thorough this approach. Operative management goals to reach a stable ankle with maximal function, decrease the risk of post-traumatic degenerative changes, and diminish the risk of complication. Nowadays, posterolateral approach is gaining the popularity due to adequate visualization and accurate anatomic reduction.展开更多
Objective The objective of this article is to summarize the development of evaluation and treatment of posterior malleolus fracture （PMF）. Data sources Data used in this Study selection Articles were review were ma...Objective The objective of this article is to summarize the development of evaluation and treatment of posterior malleolus fracture （PMF）. Data sources Data used in this Study selection Articles were review were mainly from English literature of PubMed data base. ncluded in this review if they were related to the PMF or trimalleolar fracture.展开更多
BACKGROUND Ankle fractures are common lesions of the lower limbs.Approximately 40%of ankle fractures affect the posterior malleolus(PM).Historically,PM osteosynthesis was recommended when PM size in X-ray images was g...BACKGROUND Ankle fractures are common lesions of the lower limbs.Approximately 40%of ankle fractures affect the posterior malleolus(PM).Historically,PM osteosynthesis was recommended when PM size in X-ray images was greater than 25%of the joint.Currently,computed tomography(CT)has been gaining traction in the preoperative evaluation of ankle fractures.AIM To elucidate the similarity in dimensions and to correlate PM size in X-ray images with the articular surface of the affected tibial plafond in the axial view on CT(AXCT)of a PM fracture.METHODS Eighty-one patients(mean age:39.4±13.5 years)were evaluated(54.3%were male).Two independent examiners measured PM size in profile X-ray images(PMXR)and sagittal CT(SAGCT)slices.The correlation of the measurements between the examiners and the difference in the PM fragment sizes between the two images were compared.Next,the PM size in PMXR was compared with the surface of the tibial plafond involved in the fracture in AXCT according to the Haraguchi classification.RESULTS The correlation rates between the examiners were 0.93 and 0.94 for PMXR and SAGCT,respectively(P<0.001).Fragments were 2.12%larger in SAGCT than in PMXR(P=0.018).In PMXR,there were 56 cases<25%and 25 cases≥25%.When PMXR was<25%,AXCT corresponded to 10.13%of the tibial plafond.When PMXR was≥25%,AXCT was 24.52%(P<0.001).According to the Haraguchi classification,fracture types I and II had similar PMXR measurements that were greater than those of type III.When analyzing AXCT,a significant difference was found between the three types,with II>I>III(P<0.001).CONCLUSION PM fractures show different sizes using X-ray or CT images.CT showed a larger PM in the sagittal plane and allowed the visualization of the real dimensions of the tibial plafond surface.展开更多
<strong>Background:</strong> Odontoid fractures are specific types of cervical fractures that show many challenges in their management. There are several types of Odontoid fractures with different modes of...<strong>Background:</strong> Odontoid fractures are specific types of cervical fractures that show many challenges in their management. There are several types of Odontoid fractures with different modes of stability. There is no definite widely accepted way of management of Type II fractures among spine surgeons. There is a high rate of delayed or non-union of Odontoid fracture cases that are managed conservatively which may lead to dangerous complications. If non-union occurs, the patient should undergo surgical intervention as early as possible to avoid neurological deterioration. <strong>Objective:</strong> To demonstrate the value of intra-operative reduction and posterior stabilization of atlanto-axial junction in cases of non-union old Odontoid fractures and their outcome. The study was also to check for criteria associated with a favorable outcome and if posterior decompression will be associated with a better outcome. <strong>Patients and Methods: </strong>12 patients of old neglected Odontoid fractures following conservative management and complicated by non-union were operated through intra-operative reduction with posterior stabilization and fixation of atlanto-axial junction at Al-Azhar University Hospitals during the period starting from June 2016 till the end of December 2019 using Screws and Rods. Intra-operative reduction under C-Arm X-ray and firm stabilization were aimed in all cases. Posterior cord decompression was an option in selected 4 patients with severe cord compression. Both intra-operative, post-operative radiological and clinical outcomes were assessed. <strong>Results:</strong> Good intra-operative reduction and alignment of fractured Odontoid process were obtained in all cases with use of 4 screws and 2 rods (2 screws and 1 rod on each side) in 11 cases and with using 2 screws and 1 rod (unilateral fixation) in one case. Good clinical outcome was obtained in all patients with improvement of pre-operative condition except in 3 patients where there were persistent pre-operative neurological deficits and without deterioration of pre-operative condition. Additional posterior cord decompression was associated with a better clinical outcome in 2 of 4 selected cases with severe cord compression. <strong>Conclusion:</strong> Good intra-operative reduction under C-Arm X-ray with posterior stabilization through atlanto-axial fixation using screws and rods is a reliable way of management of neglected type II Odontoid fractures complicated with non-union. Better results were obtained with less pre-operative neurological deficits and with absence of myelomalacia in MRI images. Additional posterior decompression may improve clinical outcome in cases of severe cord compression.展开更多
Background:Missed diagnosis rate of spiral tibia shaft fracture with posterior malleolus crack fracture(PMCF)is high in the clinical.However,the mechanism and related factors of fracture are still unclear.Moreover,PMC...Background:Missed diagnosis rate of spiral tibia shaft fracture with posterior malleolus crack fracture(PMCF)is high in the clinical.However,the mechanism and related factors of fracture are still unclear.Moreover,PMCF has been observed in other types of tibial shaft fractures.Objective:To explore the correlative factors of tibial shaft fracture with ipsilateral PMCF,decrease the rate of clinical missed diagnosis,strengthen the effective fixation of PMCF,and reduce the incidence of traumatic arthritis.Methods:From September 2014 to May 2019,we collected 137 tibiofibular fracture.Only 68 cases involved in ankle joint CT examination and were retrospectively analyzed.The patients were divided into posterior malleolus group(30 cases)and non-posterior malleolus group(38 cases)according to whether come up PMCF or not.The posterior malleolus group contained 24 males and 6 females,27-77(47.57±11.79)years old,the non-posterior malleolus group contained 23 males and 15 females,18-85(48.71±13.84)years old.The gender,age,location,fibula fracture and tibial shaft fracture classification were observed for univariate and multivariate analysis.Results:The probability of PMCF was higher with right tibial shaft fracture(OR=3.6995%CI:1.13-12.08 P<0.05);the probability of PMCF following distal fibular fracture was higher than that without fibular fracture(OR=11.3695%CI:1.72-75.05 P<0.05);the probability of PMCF with type A tibial shaft fracture was higher than type C(OR=4.8295%CI:1.19-19.58 P<0.05).Conclusion:Right type A tibial shaft fracture accompanied by distal fibular fracture are very important factors related to PMCF,which needs highly attention to avoid clinical missed diagnosis.展开更多
目的比较经后外侧入路由后向前三枚空心螺钉三角分布固定与钢板固定治疗累及关节面≥25%后踝骨折的临床疗效。方法回顾性分析南京大学医学院附属苏州医院2016年5月至2022年5月行外科手术治疗的63例后踝骨折患者的临床资料,其中33例行三...目的比较经后外侧入路由后向前三枚空心螺钉三角分布固定与钢板固定治疗累及关节面≥25%后踝骨折的临床疗效。方法回顾性分析南京大学医学院附属苏州医院2016年5月至2022年5月行外科手术治疗的63例后踝骨折患者的临床资料,其中33例行三枚空心螺钉三角分布固定(空心钉组),30例行钢板固定(钢板组)。比较两组患者的术中出血量、手术时间、骨折愈合时间、并发症发生率,以及术后6、12个月及末次随访时踝关节功能评分(American Orthopaedic Foot and Ankle Society,AOFAS)和踝关节活动度(range of motion,ROM)。结果63例患者均得到随访,随访时间为12~48个月,平均(20.5±2.1)个月。两组患者在平均手术时间及并发症发生率方面比较,差异有统计学意义(P<0.05),平均手术时间空心钉组短于钢板组,并发症发生率空心钉组(3.03%)低于钢板组(13.33%);而两组患者的术中出血量及后踝骨折愈合时间比较,差异无统计学意义(P>0.05)。末次随访时优良率比较,空心钉组(90.9%)与钢板组(90.0%)差异无统计学意义(P>0.05)。两组患者随访期间均未出现切口感染、内固定物松动、退出、骨不连等并发症。结论两种方法在治疗此类后踝骨折中均可取得良好的临床疗效,而空心螺钉三角分布固定具有创伤小、并发症少及易于取出等众多优点,是此类后踝骨折内固定有效且经济的方法选择。展开更多
文摘Posterior malleolus fractures are quite common and usually result from rotational ankle injuries. For the management of posterior malleolus fractures, more studies are still required, though it is already well-recognized for medial and lateral structure. Therefore, fracture of posterior malleolus is striking subject of study among orthopedic surgeons. Most orthopedic surgeons recommend fixing the posterior malleolus fracture if it is larger than 25% to 33% of the distal articular surface. Further attention is required for the reduction and fixation of fractures involving posterior malleolus. Several approaches and methods for fixation of posterior malleolus have been defined in the literature. Previously, the most common method of fixation of the posterior malleolus is by indirect reduction and antero-posterior screws, it is minimally invasive, the anterior incision does not allow satisfactory visualization of the fragment, so good anatomical reduction is difficult to achieve thorough this approach. Operative management goals to reach a stable ankle with maximal function, decrease the risk of post-traumatic degenerative changes, and diminish the risk of complication. Nowadays, posterolateral approach is gaining the popularity due to adequate visualization and accurate anatomic reduction.
文摘Objective The objective of this article is to summarize the development of evaluation and treatment of posterior malleolus fracture （PMF）. Data sources Data used in this Study selection Articles were review were mainly from English literature of PubMed data base. ncluded in this review if they were related to the PMF or trimalleolar fracture.
文摘BACKGROUND Ankle fractures are common lesions of the lower limbs.Approximately 40%of ankle fractures affect the posterior malleolus(PM).Historically,PM osteosynthesis was recommended when PM size in X-ray images was greater than 25%of the joint.Currently,computed tomography(CT)has been gaining traction in the preoperative evaluation of ankle fractures.AIM To elucidate the similarity in dimensions and to correlate PM size in X-ray images with the articular surface of the affected tibial plafond in the axial view on CT(AXCT)of a PM fracture.METHODS Eighty-one patients(mean age:39.4±13.5 years)were evaluated(54.3%were male).Two independent examiners measured PM size in profile X-ray images(PMXR)and sagittal CT(SAGCT)slices.The correlation of the measurements between the examiners and the difference in the PM fragment sizes between the two images were compared.Next,the PM size in PMXR was compared with the surface of the tibial plafond involved in the fracture in AXCT according to the Haraguchi classification.RESULTS The correlation rates between the examiners were 0.93 and 0.94 for PMXR and SAGCT,respectively(P<0.001).Fragments were 2.12%larger in SAGCT than in PMXR(P=0.018).In PMXR,there were 56 cases<25%and 25 cases≥25%.When PMXR was<25%,AXCT corresponded to 10.13%of the tibial plafond.When PMXR was≥25%,AXCT was 24.52%(P<0.001).According to the Haraguchi classification,fracture types I and II had similar PMXR measurements that were greater than those of type III.When analyzing AXCT,a significant difference was found between the three types,with II>I>III(P<0.001).CONCLUSION PM fractures show different sizes using X-ray or CT images.CT showed a larger PM in the sagittal plane and allowed the visualization of the real dimensions of the tibial plafond surface.
文摘<strong>Background:</strong> Odontoid fractures are specific types of cervical fractures that show many challenges in their management. There are several types of Odontoid fractures with different modes of stability. There is no definite widely accepted way of management of Type II fractures among spine surgeons. There is a high rate of delayed or non-union of Odontoid fracture cases that are managed conservatively which may lead to dangerous complications. If non-union occurs, the patient should undergo surgical intervention as early as possible to avoid neurological deterioration. <strong>Objective:</strong> To demonstrate the value of intra-operative reduction and posterior stabilization of atlanto-axial junction in cases of non-union old Odontoid fractures and their outcome. The study was also to check for criteria associated with a favorable outcome and if posterior decompression will be associated with a better outcome. <strong>Patients and Methods: </strong>12 patients of old neglected Odontoid fractures following conservative management and complicated by non-union were operated through intra-operative reduction with posterior stabilization and fixation of atlanto-axial junction at Al-Azhar University Hospitals during the period starting from June 2016 till the end of December 2019 using Screws and Rods. Intra-operative reduction under C-Arm X-ray and firm stabilization were aimed in all cases. Posterior cord decompression was an option in selected 4 patients with severe cord compression. Both intra-operative, post-operative radiological and clinical outcomes were assessed. <strong>Results:</strong> Good intra-operative reduction and alignment of fractured Odontoid process were obtained in all cases with use of 4 screws and 2 rods (2 screws and 1 rod on each side) in 11 cases and with using 2 screws and 1 rod (unilateral fixation) in one case. Good clinical outcome was obtained in all patients with improvement of pre-operative condition except in 3 patients where there were persistent pre-operative neurological deficits and without deterioration of pre-operative condition. Additional posterior cord decompression was associated with a better clinical outcome in 2 of 4 selected cases with severe cord compression. <strong>Conclusion:</strong> Good intra-operative reduction under C-Arm X-ray with posterior stabilization through atlanto-axial fixation using screws and rods is a reliable way of management of neglected type II Odontoid fractures complicated with non-union. Better results were obtained with less pre-operative neurological deficits and with absence of myelomalacia in MRI images. Additional posterior decompression may improve clinical outcome in cases of severe cord compression.
基金13th five-year plan Key specialty of Zhejiang Provincial Administration of Chinese medicine。
文摘Background:Missed diagnosis rate of spiral tibia shaft fracture with posterior malleolus crack fracture(PMCF)is high in the clinical.However,the mechanism and related factors of fracture are still unclear.Moreover,PMCF has been observed in other types of tibial shaft fractures.Objective:To explore the correlative factors of tibial shaft fracture with ipsilateral PMCF,decrease the rate of clinical missed diagnosis,strengthen the effective fixation of PMCF,and reduce the incidence of traumatic arthritis.Methods:From September 2014 to May 2019,we collected 137 tibiofibular fracture.Only 68 cases involved in ankle joint CT examination and were retrospectively analyzed.The patients were divided into posterior malleolus group(30 cases)and non-posterior malleolus group(38 cases)according to whether come up PMCF or not.The posterior malleolus group contained 24 males and 6 females,27-77(47.57±11.79)years old,the non-posterior malleolus group contained 23 males and 15 females,18-85(48.71±13.84)years old.The gender,age,location,fibula fracture and tibial shaft fracture classification were observed for univariate and multivariate analysis.Results:The probability of PMCF was higher with right tibial shaft fracture(OR=3.6995%CI:1.13-12.08 P<0.05);the probability of PMCF following distal fibular fracture was higher than that without fibular fracture(OR=11.3695%CI:1.72-75.05 P<0.05);the probability of PMCF with type A tibial shaft fracture was higher than type C(OR=4.8295%CI:1.19-19.58 P<0.05).Conclusion:Right type A tibial shaft fracture accompanied by distal fibular fracture are very important factors related to PMCF,which needs highly attention to avoid clinical missed diagnosis.
文摘目的比较经后外侧入路由后向前三枚空心螺钉三角分布固定与钢板固定治疗累及关节面≥25%后踝骨折的临床疗效。方法回顾性分析南京大学医学院附属苏州医院2016年5月至2022年5月行外科手术治疗的63例后踝骨折患者的临床资料,其中33例行三枚空心螺钉三角分布固定(空心钉组),30例行钢板固定(钢板组)。比较两组患者的术中出血量、手术时间、骨折愈合时间、并发症发生率,以及术后6、12个月及末次随访时踝关节功能评分(American Orthopaedic Foot and Ankle Society,AOFAS)和踝关节活动度(range of motion,ROM)。结果63例患者均得到随访,随访时间为12~48个月,平均(20.5±2.1)个月。两组患者在平均手术时间及并发症发生率方面比较,差异有统计学意义(P<0.05),平均手术时间空心钉组短于钢板组,并发症发生率空心钉组(3.03%)低于钢板组(13.33%);而两组患者的术中出血量及后踝骨折愈合时间比较,差异无统计学意义(P>0.05)。末次随访时优良率比较,空心钉组(90.9%)与钢板组(90.0%)差异无统计学意义(P>0.05)。两组患者随访期间均未出现切口感染、内固定物松动、退出、骨不连等并发症。结论两种方法在治疗此类后踝骨折中均可取得良好的临床疗效,而空心螺钉三角分布固定具有创伤小、并发症少及易于取出等众多优点,是此类后踝骨折内固定有效且经济的方法选择。
